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目的探讨超声内镜引导下深挖活检早期诊断直肠类癌以及内镜下黏膜切除术治疗直肠类癌的安全性、有效性。方法在超声内镜引导下深挖活检、结合病理及免疫组化检查,诊断直肠类癌24例。对24例直肠类癌的内镜及超声影像特点进行回顾性分析,总结其特征。对病灶直径小于1.5 cm、浸润深度不超过黏膜下层、无肝转移及腹水发生的直肠类癌采取内镜下黏膜切除术治疗。结果 24例直肠类癌分别距离肛缘5 cm~12 cm,病灶大小0.8cm~1.5 cm,术后切除的标本切缘完整,基底无残留,治疗过程中均未发生穿孔,无迟发性出血,术后创面即刻渗血1例,经内镜治疗血止。随访3至5年无转移及再发。结论直肠类癌可通过超声内镜引导下深挖活检,钳取组织行病理及免疫组化检查而确诊,内镜下黏膜切除术治疗直径小于1.5 cm的直肠类癌简单、安全有效。
Objective To investigate the safety and effectiveness of early diagnosis of rectal carcinoid tumor under endoscopic ultrasonography guided by endoscopic resection of rectal carcinoid. Methods Under the guidance of endoscopic ultrasonography, deep biopsy was performed. Combined with pathology and immunohistochemistry, 24 cases of rectal carcinoids were diagnosed. The characteristics of endoscopic and ultrasonographic features of 24 cases of rectal carcinoids were analyzed retrospectively. Lesions less than 1.5 cm in diameter, infiltration depth does not exceed the submucosa, no liver metastasis and ascites carcinoid rectal carcinoid to take endoscopic mucosal resection. Results 24 cases of rectal carcinoid tumors were 5 cm to 12 cm respectively from the anal verge and the size of the lesions was 0.8 cm to 1.5 cm. The resected specimens were intact with no residual basement. No perforation and no delayed hemorrhage occurred during the treatment Immediately after operation wound bleeding in 1 case, endoscopic treatment of blood only. Follow-up 3-5 years without metastasis and recurrence. Conclusions Rectal carcinoids can be diagnosed by deep endoscopic ultrasonography guided biopsy. The pathological and immunohistochemical examination of the tissue is performed by forceps. Endoscopic mucosal resection is simple, safe and effective for the treatment of rectal carcinoid tumors less than 1.5 cm in diameter.